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Are Rapid Diagnostics Replacing Prediction Scores?

Julie Ann Justo, PharmD, MS, BCPS-AQ ID, explains how rapid diagnostics interplay with prediction scores in antimicrobial stewardship programs.

Segment Description: Julie Ann Justo, PharmD, MS, BCPS-AQ ID, clinical assistant professor, University of South Carolina College of Pharmacy, explains how rapid diagnostics interplay with prediction scores in antimicrobial stewardship programs.

Interview transcript (modified for readability):

“Rapid diagnostics are certainly very popular with antimicrobial stewardship programs right now. There’s lots of literature to support that they also can improve empiric antibiotic selection. At that point, you might even start calling it somewhat definitive therapy because they’re giving you information about certain resistance genes—in some cases, it depends on the product that you’re using.

And so, I think on the surface of it, some folks might initially think that rapid diagnostics would replace prediction scores and prediction scores would no longer be necessary. And that’s just because if you’re getting data that tells you it’s methicillin-susceptible Staphylococcus aureus (MSSA) within 6 hours, why do you need to run a prediction score on a patient?

I would argue that as far as I’m aware of there’s nothing at time zero, at the moment that the physician is placing the initial order for empiric antibiotics or other antimicrobials that is really going to—there’s nothing on the rapid diagnostic sphere—that’s going to help you with that at time zero.

We know most folks are going to stick with the first regimen that they pick. So, even if we have really good rapid diagnostics my view is that they’re working in concert with prediction scores. Prediction scores are still the thing that probably works the best at time zero, but even still, at our institution we combine the 2. We have the information from the risk scores and we also have information from rapid diagnostics and then we’re tweaking our antimicrobial regimen as we go along based on both of those. Based on my estimation I think both are very useful for stewardship programs, depending on the resources that you have available at your institution.”